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As we get older, years and decades of mechanical stress may lead to deterioration of joints, ligaments, and tendons. This degenerative process, commonly known as arthritis, primarily affects weight-bearing joints such as the hips and knees and those found in the lumbar spine. The shoulder, too, is especially prone to undergo arthritic changes owing to its extreme mobility. The extensive range of motion at the shoulder is built-in to the design of this structure, but the tradeoff is instability. The design of the shoulder sacrifices stability for mobility.

Degenerative disorders of the shoulder typically involve the rotator cuff. This broad, flat structure is composed of the muscle-tendon units of the four rotator cuff muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. The thick covering of the rotator cuff surrounds the head of the arm bone and supports and strengthens the shoulder joint. But owing to the shoulder’s inherent instability contrasted with its great mobility, the soft tissues of the rotator cuff undergo repetitive stress and strain. Ultimately, degenerative changes may occur, leading to the two prominent symptoms of pain and restricted range of motion.

An entire orthopedic sub-specialty focuses on treatment of chronic shoulder pain and includes long-term use of anti-inflammatory medication, corticosteroid injections when medications do not provide sufficient relief, and eventually surgery to repair tears in the various rotator cuff tendons. “Revision” surgery is commonly performed when the benefits of prior surgery are exhausted.¹

The good news is that in many cases, a more optimal approach is available, one that utilizes the body’s own natural recuperative powers. For many people, chronic shoulder pain can be reduced and chronic loss of mobility can be improved by engaging in specific activities and performing specific rehabilitative exercises. The goals of rehabilitation are to increase shoulder range of motion and build up shoulder strength. As these goals are accomplished, the likely result is reduction of intensity and frequency of occurrence of shoulder pain.

Engaging in an overall strength training program is an important general approach to managing chronic shoulder pain.^2,3 Strength training should be done progressively, starting with light weights and building up over time. Exercises specific to the shoulder include seated dumbbell or barbell presses, dumbbell or cable lateral raises, seated bent-over rows, and internal and external rotation exercises done with very light dumbbells on a flat bench. If one has experienced an acute shoulder injury, early rehabilitation should precede rehabilitative strength training. Early rehabilitation includes pendulum exercises and finger-walking up a wall in both forward-facing and side positions.

Your chiropractor is experienced in injury rehabilitation and will be able to help you design an effective flexibility and strengthening program for improved shoulder function.

¹Keener JD: Revision rotator cuff repair. Clin Sports Med 31(4):713-725, 2012

²Lewis JS: A specific exercise program for patients with subacromial impingement syndrome can improve function and reduce the need for surgery. J Physiother 58(2):127, 2012

³Andersen LL, et al: Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain 152(2):440-446, 2011

Chronic knee pain is notoriously difficult to treat successfully. Persons with these problems often become discouraged as they shuttle from specialist to specialist, from rheumatologist to orthopedic surgeon to physical therapist to acupuncturist and back again. Lack of progress and improvement becomes understandable when one considers that typical evaluation and treatment are directed at the symptoms. But with chronic knee pain, and many other pain syndromes, actual benefits may be obtained by addressing underlying biomechanical problems.

Faulty biomechanics are at the root of many ongoing knee problems. Of course, various other diseases and orthopedic conditions may cause the same type of chronic pain. The most likely of these possibilities need to be considered and ruled out before a diagnosis of biomechanical knee pain is established. Osteochondritis dissecans, a torn meniscus, and synovial effusion are all frequently encountered in persons over age 40 with chronic knee pain. Rheumatoid arthritis, lupus, and ankylosing spondylitis are a few rheumatologic conditions which may result in sporadic or chronic knee pain.¹

When these medical entities have been eliminated as possibilities, a biomechanical causation becomes probable. How does a person develop “faulty biomechanics”? In fact, most of us have never received effective instruction in how to use our bodies. We stand and sit in all kinds of unsound postures, slouching and slumping and generally giving in to every available force of gravity. We stand with all our body weight on one leg, neck and shoulder muscles gripped tightly and abdominal muscles sagging and protruding. When we sit we slump down, stressing the lower back with poorly tolerated mechanical forces, or sit for hours with legs crossed, stressing the lower back, hips, and knees.

Over the course of a lifetime, our bodies have continually tried to adapt to a range of inefficient and stressful postures and habits. But eventually no more adaptation is possible.² As a result joints, muscles, ligaments, and tendons break down and fail. We experience this failure as pain. And once this type of pain has started, it is not going to go away unless the underlying causes are corrected. Specifically, the person’s biomechanics need to be restored closer to normal.

Correction of posture takes time and can only be accomplished gradually. The key is to learn what to do, learn how to do it, and to be working on posture every day.³ The most important thing is to begin. Three basic biomechanical corrections are as follows: (1) When standing, be sure to have your weight over the balls of your feet and to have your weight evenly distributed on both legs. (2) Activate your deep abdominal muscles by visualizing an “inner lift”. (3) Have straight lines of force running down your legs (rather than lines of force crossing at your knee, creating torsion and tension). Visualize “straight energy” flowing from your hip sockets, straight down through the center of your knees, straight down to your feet, between your first and second toes.

Visualizing and implementing these three biomechanical corrections on a daily basis represents the first series of steps toward improving knee mechanics and reducing chronic knee pain.

¹Yusuf E, et al: Do knee abnormalities visualised on MRI explain knee pain in knee osteoarthritis? A systematic review. Ann Rheum Dis 70(1):60-67, 2011

²Suri P, et al: Low back pain and other musculoskeletal pain comorbidities in individuals with symptomatic osteoarthritis of the knee: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken) 62(12):1715-1723, 2010

³Bennell KL, Hinman RS: A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport 14(1):4-9, 2011

The condition of fibromyalgia creates many challenges for a person with this disorder. These challenges often go far beyond the characteristic chronic pain which alone can be potentially debilitating. Those with fibromyalgia have pain in many locations and the presence of multiple pain sites is often confusing to their doctor or doctors. Family physicians, internists, endocrinologists, and even pain management specialists and rheumatologists often have great difficulty in comprehending the full extent of fibromyalgia and the serious health and well-being issues that are caused by the disorder.

Persons with fibromyalgia have so many symptoms that an uninformed physician may find it easier to refer such patients to a psychologist or psychiatrist. But the physical symptoms of fibromyalgia are real. The sufferers have widespread pain on a chronic basis. Additional symptoms include fatigue, sleep disturbances, numbness or tingling in the hands and feet, joint stiffness, and cognitive dysfunction (brain fog). Depression commonly affects those with fibromyalgia.

Owing to the presence of so many chronic symptoms, fibromyalgia is notoriously difficult to treat. Such patients are typically taking multiple medications, prescribed by multiple specialists attempting to combat the problems that fall within their particular branch of medicine – pain management, rheumatology, and psychology/psychiatry.

Despite taking several medications on a long-term basis, most fibromyalgia patients tend not to improve. Depression and chronic pain take a profound toll, and daily living becomes quite burdensome. Many fibromyalgia patients despair of ever finding even a partial solution.

Attempts to address the problems of fibromyalgia by just treating the symptoms often fail. As the physiologic causes of the disorder are unknown, holistic approaches have a much greater likelihood of success. Multidisciplinary treatment is needed to impact this systems-wide disorder, including chiropractic care, nutritional recommendations, psychological counseling, and a gradual return to increased levels of physical activity and exercise.^{(1, 2, 3)}

Headaches are an unfortunate and painful part of life for many Americans. In fact, an estimated five percent of adults in this country suffer from chronic migraines or severe headache pain.

We spend billions of dollars each year on over-the-counter and prescription pain medication for relief from those nagging headaches. But these drugs have the potential to cause even more pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), a type of medication including OTC brands such as Advil, Motrin, and Excedrin, have been associated with side effects like stomach bleeding and ulcers, and even liver failure. In fact, one possible side effect of many NSAIDs is a headache!

And if you manage to avoid the side effects, these medications really only mask or diminish symptoms. But it’s the cause that counts and that’s where chiropractic comes in. Here’s how: The nervous system is the “master system” in the body, controlling and coordinating all other systems – respiratory, immune, circulatory, etc. Sometimes, there are areas in the spine where one or more of the vertebrae may have experienced a loss of function, creating pressure on, or otherwise irritating, spinal nerves. This irritation interferes with the signals, or “communication,” traveling over those nerves, which can compromise the health and proper function of every system in the body. Regular adjustments by your chiropractor can positively affect the nervous system, aid nerve transmission and thus, the body’s ability to heal itself.

Still a skeptic? Scientific research indicates chiropractic is an effective, natural answer to headache pain. During a major 1995 study comparing several weeks of drug therapy to several weeks of chiropractic care, 82 percent of patients given drug therapy reported side effects including drowsiness, weight gain and dry mouth. Heart-related problems and glaucoma also were associated with the drug therapy. On the other hand, chiropractic patients reported no side effects. And after four weeks of treatment, patients who used drugs began having headaches again, while members of the chiropractic group continued to express headache relief, as well as higher levels of energy as compared to the drug therapy group.

So put down the pain-relief medications, talk to your chiropractor about your chronic headaches, and experience a natural, drug-free approach to headache relief, today!

In the United States, about 20 million people have been diagnosed with asthma; nearly 9 million of them are children. The most common treatment for Asthma has been the use of corticosteriod inhalers.

A new study found that breathing techniques can cut the use of asthma reliever inhalers by more than 80% and halve the dose of preventer inhaler required in mild asthma, research finds.

The new study, published in the journal Thorax, compared the impact of two breathing techniques on symptoms, lung function, use of medication and quality of life among 57 adults with mild asthma.

One technique focused on shallow, nasal breathing with slow exhalations, and the second technique used general upper body exercises, accompanied by relaxation.

The participants, who used a preventer inhaler and required reliever inhaler at least four times a week, were randomly assigned to one or other breathing technique.

Participants practiced their breathing exercises twice a day for around 25 minutes over a period of 30 weeks. They were also encouraged to use a shorter version of their exercises in place of reliever inhaler, and to use reliever if the exercises did not work.

Researcher Professor Christine Jenkins, of the the Woolcock Institute of Medical Research, Sydney, New South Wales, Australia, found that the use of reliever medication fell by 86% in both exercise groups, a process which began within weeks of starting the exercises, and was maintained over eight months. She writes: “Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently.”

By the end of the study, the participants dropped from using around three puffs of their reliever inhaler each day to approximately one puff every third day. Preventer dose requirements were also cut in half.

Allergies and asthma are big business. Approximately 50 million Americans suffer from allergies, and approximately 20 million suffer from asthma. With some overlap between the conditions, more than 60 million Americans experience either allergies, asthma, or both.

The costs for medications, hospital and emergency room admissions, and loss of business productivity are huge – approximately $18 billion annually.¹ And, the impact on children is significant and ongoing – 14 million school days are missed annually due to allergies and asthma. These disorders are the number one reason for school absenteeism.²

Standard treatment for allergies and asthma consists of a variety of medications, and if you have one of these disorders, you know all about the meds. For allergies, typical medications include antihistamines and corticosteroid nasal sprays. You may also undergo more aggressive therapy – desensitization injections, known as immunotherapy, which are given regularly over a period of years.

For asthma, the gold standard of medication is inhaled corticosteroids. Asthma inhalers are now so much a part of daily life that they appear regularly as props on television serials and in film. In plot-driven, contrived “difficult” moments, lead actors – children and adults – pull out their inhalers and take a quick dose.

The challenge, of course, with allergy and asthma medication is there is no end-point. There is no cure. Asthma and allergies, for the most part, are lifelong conditions requiring lifelong medication. Might there be a better way, an alternative solution?

“Alternative” is the key word. Medical treatment is designed to combat symptoms, and is successful to a certain extent with allergies and asthma. Underlying causes are not addressed, however, and symptoms continue year after year. What else might be done?

Enter chiropractic care. Chiropractic health care, with its unique comprehensive approach, is able to offer positive benefit to a variety of conditions and ailments. In the case of allergies and asthma, these “hypersensitivity conditions” may respond well to therapy designed to normalize the body’s flow of nerve signals. To use a metaphor, chiropractic treatment removes roadblocks to the body’s natural healing abilities. Restoring these imbalances may help reduce such hypersensitivity reactions.

Chiropractic care frequently includes nutritional counseling, a critical component for people with allergies and asthma. Such individuals need as much physical optimization as possible, and nutritional awareness is key. A balanced food plan will help support all metabolic systems, reduce irritation caused by deficiencies, and provide fuel for exercise programs.

The benefits of chiropractic care are wide-ranging, and may be very useful in cases of hypersensitivity disorders such as allergies and asthma.

¹Weiss K: The costs of asthma. Asthma and Allergy Foundation, 1998 [updated 2001].
²The Condition of Education, National Center for Education Statistics, 2001.

It used to be that osteoporosis was considered a disease that affected only the elderly. We particularly associated osteoporosis with older women whose backs were slightly hunched over or those who could no longer stand up straight. Today, the truth is that an estimated 20 million American women suffer from osteoporosis, and 80 percent of them don’t even know it.

Osteoporosis is a chronic, progressive condition that steals bone from the body, leading to fractures of the hip, spine and wrist. Older people can suffer disability and even death from osteoporosis-related fractures. Alarmingly, one in two women and one in eight men will suffer from an osteoporosis-related fracture in his or her lifetime.

Many people confuse osteoporosis with arthritis, and wait for swollen joints and discomfort before being tested. Even though osteoporosis is painless until a bone fracture occurs, it is important to find out how healthy your bones are now and if need be, adjust your lifestyle to avoid this brittle bone disease. The American Chiropractic Association recommends the following tips to maintain healthy bones:

• Start a regular exercise program. Walking, skipping rope, jogging, playing racquet sports, swimming and aerobics are all helpful in reducing the risk of osteoporosis. Exercising for 20 minutes, three times a week, is helpful.
• Although weight lifting exercises are generally recommended, the National Osteoporosis Foundation says those suffering from osteoporosis should consult their health care practitioner before beginning a weight lifting program because excessive strain on the bones could result.
• Those with severe osteoporosis and who have suffered from fractures may find Tai Chi, a form of martial arts, to be a beneficial strength training exercise system.
• People suffering from osteoporosis should be careful when bending and lifting heavy objects, including grandchildren. Bend from the knees, not the waist, when lifting, and try to avoid hunching while sitting or standing.
• Be sure to include calcium in your daily diet. The National Institutes of Health’s recommendations are 1,000 mg/day for post-menopausal women taking estrogen; 1,500 mg/day for postmenopausal women not taking estrogen, and 1,500 mg/day for men and women over 65 years of age.
• If you are looking for a calcium supplement, try one that’s highly absorbable, such as microcrystalline hydroxyapatite concentrate (MCHC), or one of the malates, fumarates, succinates, glutarates, or citrates. But don’t overdo it. Taking more than the recommended amount of calcium may cause kidney stones.
• Consider taking additional nutritional supplements, such as vitamin D, C, magnesium, zinc and silica after consulting with your doctor of chiropractic.
• Eat a healthy, balanced diet, including fresh vegetables, fruit, nuts and seeds. Try broccoli, kale, collard greens, cabbage and turnip greens. Experiment with tofu, salmon, sardines and grains. Low-fat milk and/or yogurt are good sources of calcium. (A glass of low-fat milk and a cup of yogurt add 600 mg of calcium to your daily diet.)
• Drink 8 eight-ounce glasses of water a day (herb teas, juices and coffee are not a substitute for water.) Avoid caffeine, carbonated sodas, alcohol, baked goods and junk food.
• Watch your animal protein intake.

Stress, sleep deprivation and fatigue have been no small component of Dr. Michael Benson’s life. As a fetal surgeon, Benson is often up for 24- to 36-hour stretches at a time looking after patients. He has little time to rest or eat regular, healthy meals. It’s no wonder he has suffered from migraines for years.

Benson is not alone. It’s estimated that 28 million Americans suffer from migraines. As anyone who experiences these intense headaches can tell you, they can be extremely debilitating. Acute pain, possible visual disturbances and nausea, as well as sensitivity to light, sounds and odors can render a person incapable of going about everyday responsibilities, much less performing complicated tasks like surgery.

In order to cope, Benson has used Ibuprofen and heat to manage the pain, but sometimes it doesn’t work. “I used to keep a preloaded syringe of Toradol [a strong, anti-inflammatory pain reliever] in my medicine chest,” he admits, “because once my headaches get really bad, I get nauseated and can’t take anything by mouth. It saved having to go to the ER.”

Having trained as an M.D., Benson confessed that chiropractic treatment wasn’t in his knowledgebase or on his immediate list of pain-relieving measures. In fact, if he hadn’t been visiting his brother, a doctor of chiropractic, when a bad migraine hit, he may never have received chiropractic care. “The Ibuprofen didn’t work, so my brother offered to examine me and adjust my neck,” he says. “When you’re in pain, you’re willing to try anything.” Within 10 to 15 minutes of the adjustment, his migraine had disappeared.

It’s likely that Benson’s body reacts to stress by tensing muscles around the cervical joints in the neck, causing nerves in his neck to become impinged and triggering his migraines. Chiropractic adjustment alleviates this pain by relaxing muscles and promoting a full range of motion in the neck, allowing the headache to subside. And Benson’s positive experience isn’t uncommon. Recent studies at Duke University found that spinal manipulation was almost always immediately effective in relieving headaches originating in the neck and provided longer-lasting relief than commonly prescribed pain medications.

Benson’s migraines probably won’t go away completely without substantial lifestyle changes— changes that could be tough to implement with his profession. Once migraines are an established pattern, they are very difficult to get rid of, explains his brother. But he can work to minimize them with chiropractic care— a solution that doesn’t carry the potential side-effects of over-the-counter and prescription pain medication. Whenever a potentially incapacitating migraine hits and Benson gets an adjustment from his brother, “It always works,” he says.

If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea.

What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative.

Research shows that spinal manipulation – the primary form of care provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck.

A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.

Also, a 1995 study in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulative therapy is an effective treatment for tension headaches and that those who ceased chiropractic treatment after four weeks experienced a sustained therapeutic benefit in contrast with those patients who received a commonly prescribed medication.

Headache Triggers

But to get to the bottom of the problem, you first need to find out what is causing your pain. Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems.

Ninety-five percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease. The headache itself is the primary concern.

What Can You Do?

• If you spend a large amount of time in one fixed position, such as in front of a computer, on a sewing machine, typing or reading, take a break and stretch every 30 minutes to one hour. The stretches should take your head and neck through a comfortable range of motion.
• Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-impact aerobics.
• Avoid teeth clenching. The upper teeth should never touch the lowers, except when swallowing. This results in stress at the temporomandibular joints (TMJ) – the two joints that connect your jaw to your skull – leading to TMJ irritation and a form of tension headaches.
• Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.

In addition, the ACA and its Council on Nutrition suggest you avoid the following food “triggers”:

• Avoid caffeine. Foods such as chocolate, coffee, sodas and cocoa contain high levels of the stimulant.
• Avoid foods with a high salt or sugar content. These foods may cause migraines, resulting in sensitivity to light, noise, or abrupt movements.
• Avoid drinking alcoholic beverages. These drinks can dehydrate you and cause headache pain.
• Other headache sufferers may want to avoid not only caffeine, but also high-protein foods, dairy products, red meat and salty foods.

What Can a Doctor of Chiropractic Do?

Chiropractors may do one or more of the following if you suffer from a primary headache:

• Perform spinal manipulation or chiropractic adjustments to improve spinal function and alleviate the stress on your system.
• Provide nutritional advice, recommending a change in diet and perhaps the addition of B complex vitamins.
• Offer advice on posture, ergonomics (work postures), exercises and relaxation techniques. This advice should help to relieve the recurring joint irritation and tension in the muscles of the neck and upper back.

Doctors of chiropractic undergo extensive training to help their patients in many ways – not just back pain.

If your headache is symptomatic of a health problem that needs the care of another discipline, your doctor of chiropractic will refer you to an appropriate specialist.

The worldwide type 2 diabetes epidemic has been thoroughly documented.^1,2 Yet despite extensive study and analysis, there has been little actual progress in slowing the spread of this chronic disease. Numerous medications such as metformin and glyburide are available to help counter the severe problems that result from unchecked diabetes. But if the person with diabetes doesn’t assist in the process of getting well, the disease will continue on its unrelenting course. There are many important steps a diabetic patient can take to improve his or her health status. Better still, these same steps may be implemented by healthy persons to ward off type 2 diabetes in the first place.

In type 2 diabetes, the cells of your body become resistant to the effects of insulin. Normally, the hormone insulin promotes the absorption of glucose from the blood by muscle cells and fat cells. With insulin resistance, glucose fails to be properly absorbed by these cells and blood levels of glucose rise. Over time, some of this excess glucose is converted into fat, increasing the person’s weight, causing high blood pressure, and placing undue stress on the heart. Further, prolonged exposure to excess glucose damages small blood vessels and nerve fibers, leading to significant pain along large nerve tracts (neuropathies), loss of circulation to and even amputation of a lower limb, kidney disease, kidney failure, eye disease, and blindness.

Thus, diabetes can be devastating for both patients and their families. The annual public health costs related to diabetes treatment are huge. Diabetes costs in the U.S. were $245 billion in 2012, representing $176 billion in direct medical costs and $69 billion in lost productivity. Worse, in 2012, 9.3% (29.1 million) of Americans had diabetes, up from 8.3% (25.8 million persons) in 2010. Costs of diabetes to patients, families, and society continue to rise.

The only feasible method of combating the worldwide diabetes epidemic focuses on individual initiative. Medical treatment, by definition, arrives after the fact, typically years after the diabetes process has been set in motion. Prevention is the best strategy. Adopting a lifestyle that, indirectly, leads to appropriate utilization of insulin rather than insulin resistance offers a real, effective solution to diabetes prevention. More than 20 years of research has demonstrated that 30 minutes of vigorous exercise a day, combined with a healthy diet and sufficient rest, will substantially assist a person in avoiding chronic diseases such as diabetes.³ Personal accountability and personal responsibility are called for. It is up to each of us to make such choices in the best interest of ourselves and our families.

¹Vollenweider P, et al: HDLs, Diabetes, and Metabolic Syndrome. Handb Exp Pharmacol 224:405-421, 2015
²Skrha J: Diabetes mellitus–a global pandemic. Keynote lecture presented at the Wonca conference in Prague in June 2013. Eur J Gen Pract 20(1):65-68, 2014
³Orio F, et al: Lifestyle changes in the management of adulthood and childhood obesity. Minerva Endocrinol 2014 Dec 17. [Epub ahead of print]